South Dakota Drug and Alcohol Inpatient Treatment Licensing

Author: A. Ant, CADC-II, Licensing & Accreditation Expert

Disclaimer: This content is provided for general informational purposes only and should not be construed as legal, regulatory, or licensing advice. Requirements change frequently. Consult qualified professionals for guidance specific to your situation.

Apply now: DOH facility license through the “Apply Online” link on the Health Facility Licensure page, and DSS accreditation through the Office of Licensing and Accreditation inquiry form | Questions: Julie Jenssen, DOH, 605-773-3901, Julie.Jenssen@state.sd.us, and DSS at 605.773.3165

A residential addiction program in South Dakota deals with two departments, and they don’t even use the same verb. The Department of Health licenses the building as an inpatient chemical dependency treatment facility. The Department of Social Services accredits the treatment program. Only the first is plainly mandatory. SDCL 34-12-2 bars anyone from operating a health care facility “without first obtaining a license from the South Dakota Department of Health,” the chapter’s definitions count “any facility that provides a structured inpatient treatment program for alcoholism or drug abuse” as one of those facilities, and SDCL 34-12-18 makes running one unlicensed a Class 1 misdemeanor.

This guide is about adult residential treatment and residential detoxification. Outpatient, intensive outpatient and day treatment are covered in South Dakota Drug and Alcohol Outpatient Treatment Licensing, and psychiatric hospitals, community mental health centers and the rest of the state’s categories are mapped on South Dakota Behavioral Health Licensing.

The DOH License and the DSS Accreditation, Side by Side

Everything in this table is taken from the Legislature’s official code and rule pages and the two departments’ own websites. The last column of the second row is our reading, and we say so there.

Question	Department of Health license	DSS accreditation
Legal basis	SDCL 34-12, ARSD 44:78 (Inpatient Chemical Dependency Treatment Facility)	SDCL 34-20A, ARSD 67:61 (Substance Use Disorders)
Is it required?	Yes. Operating without it is a Class 1 misdemeanor (SDCL 34-12-18)	The rule says an agency “may apply” (67:61:02:03). Our reading is that it’s voluntary, though residential programs rarely skip it (see below)
Annual fee	$150 (up to 16 beds), $300 (17 to 50 beds) or $450 (51 beds and up) a year (SDCL 34-12-6)	The statute lets DSS set inspection fees (34-20A-27). We found no published amount
What gets inspected	“licensure, physical environment and safety, fire safety, construction standards, and accessibility” (44:78:01:10)	A comprehensive survey scored against ARSD 67:61
Correcting deficiencies	Plan of correction within 10 days of the statement of deficiencies (44:78:01:07)	Report within 30 days of the survey, then a plan of correction within 30 days of receiving it (67:61:02:09)
Staff on duty	“At least two staff members shall be on duty at all times,” with one on each floor that has occupied beds (44:78:03:02)	Set by level of care in 67:61:04:09 (see the staffing section)

DSS rule 67:61:10:03 is what ties the two together: “Each residential facility seeking accreditation or providing services must be licensed pursuant to article 44:78.” An operator who goes to DSS first will be sent back to DOH for the building.

Does ARSD 44:78 Reach a 3.1 House or a Detox Unit?

This is the open question we’d settle before signing a lease. The DOH article is short, three chapters covering general rules, physical environment and fire safety, and it describes its facilities one way only. ARSD 44:78:01:10, unchanged since October 2015, says “Inpatient chemical dependency treatment facilities are Level III.7 medically-monitored intensive inpatient treatment programs.” The words “detox,” “residential” and “III.1” don’t appear anywhere in the article.

The statute is broader. Its definition takes in any facility with a structured inpatient program, and DSS’s 67:61:10:03 says every residential facility needs a 44:78 license. DSS accredits three residential classes under 67:61:02:03: clinically-managed low-intensity residential, clinically-managed residential detoxification, and medically-monitored intensive inpatient. Our reading is that the statute and the DSS rule point toward a DOH license for all three, even though the DOH rule text only names the last. We haven’t seen DOH say how it handles a low-intensity house or a freestanding detox in practice, so put the question to Julie Jenssen at 605-773-3901 and get the answer in writing.

Accreditation, the Score, and the National Accreditor Route

Nothing in SDCL 34-20A, which we read in full on the Legislature’s site, says a residential program must hold DSS accreditation to open. What the chapter does is hang several things on being “accredited.” SDCL 34-20A-2.1 deems an accredited facility “approved by the state” for purposes of SDCL 58-18-7.1, an insurance statute, and commitment orders under SDCL 34-20A-77 go “to any appropriate accredited treatment facility.” A residential program that wants court commitments, or the state approval that SDCL 58-18-7.1 looks for, needs accreditation. State funding also keys off it in our reading, which is a payer matter outside the license and outside the work we do.

The state survey is graded. At renewal, under 67:61:02:08, DSS decides within 90 days of the on-site survey, issues a three-year certificate at 90 percent compliance or better, a two-year certificate at 70 to 89 percent, and puts the agency on probation below 70. A new agency starts with provisional accreditation, which “expires after six months” and can be extended no more than three months with the department’s approval (67:61:02:06). If the comprehensive survey goes well, the first full certificate for a new agency runs one year.

The statute also names the national accreditors. Under SDCL 34-20A-2, accreditation from The Joint Commission, CARF or the Council on Accreditation, or a passed Indian Health Service quality assurance review, makes a facility accredited for state purposes if it sends proof, recommendations and related correspondence to the department “in a timely manner.” SDCL 34-20A-44 then says the department’s inspection duty “does not apply” to those facilities, while 34-20A-44.1 keeps DSS’s right of access to investigate complaints. The DSS accreditation chapter, 67:61:02, doesn’t mention national accreditation at all, so we can’t tell you whether a CARF residential program skips the state survey in practice. Ask the Office of Licensing and Accreditation before you count on it. The DOH license has no deemed-status provision that we found, so a DOH inspection happens regardless.

Clinical Requirements by Residential Level

Each residential class has its own chapter in ARSD 67:61. In a clinically-managed low-intensity residential program, clients receive at least five hours a week of individual, group or family counseling (67:61:16:03). A medically-monitored intensive inpatient program sets a far higher floor, at least 21 hours a week of counseling for adults plus 9 hours on specialized topics (67:61:18:05), and within eight hours after admission “each client must receive a medical evaluation conducted by a registered nurse or a licensed practical nurse” (67:61:18:02).

Both the detoxification program (67:61:17) and the intensive inpatient program (67:61:18:03) need a medical director. The program can sign a written agreement with “a licensed physician, physician assistant, or certified nurse practitioner” or employ a physician in the role. In the 3.7 program, the medical director’s duties include “Providing emergency medical care to admitted clients.”

ASAM Labels and CARF’s Level of Care Certification

South Dakota’s program names follow ASAM’s vocabulary, and the DOH rule uses “Level III.7,” but the DSS eligibility rules don’t cite ASAM, and nothing we read requires an ASAM certification. Matching a DSS class to an ASAM number is our own reading. If a referral source or payer wants proof of the level, CARF’s ASAM Level of Care Certification is a separate credential, delivered with ASAM, that “currently covers adult residential programs at levels 3.1, 3.5, and 3.7.” South Dakota has no stand-alone 3.5 class, so for most operators here the fit is a low-intensity house at 3.1 or an intensive inpatient program at 3.7. Neither CARF nor ASAM describes the certification as covering withdrawal management, so it doesn’t fit the detoxification class. Your DOH license and DSS certificate won’t show it, but anyone can check it in CARF’s provider search using the ASAM Level of Care filter.

Medication for Opioid Use Disorder in a Residential Program

We did not find a South Dakota rule requiring a residential program to offer or allow medications for opioid use disorder. The admission policy rule (67:61:07:02) and the 3.7 service rule don’t mention them. That doesn’t make a no-MOUD policy wise, and in our experience referral sources ask about it early.

How medication gets handled on site depends on staffing. ARSD 67:61:08:06 defines administration in a residential program as giving medication, other than by the parenteral route (injection or infusion) or a nasogastric tube, “under the supervision of a licensed registered nurse,” and the chapter lets RNs, LPNs or trained unlicensed assistive personnel do it. A program without any of those staff must make the medication available “for self-administration in accordance with the instructions of a licensed physician.” Buprenorphine fits either model. DEA’s January 12, 2023 letter to registrants says “all prescriptions for buprenorphine only require a standard DEA registration number,” and in South Dakota a prescriber also needs a state controlled substance registration from DOH. Methadone is different. ARSD 67:61 has no opioid treatment program chapter, and methadone for OUD comes only from a federally certified opioid treatment program, so a residential program should have a written coordination agreement with one. A named partner in your policy reads better to a surveyor than a general promise to refer out.

Adding Ketamine to a South Dakota Residential Program

Neither DSS nor DOH has published anything on ketamine that we could find. What follows applies the medication, staffing and notice rules we cite to a resident receiving ketamine for co-occurring depression or PTSD, and the conclusions are ours.

The accreditation rules leave room for it, and the real limits come from staffing. Ketamine isn’t a level of care, and the notice rule in 67:61:02:20 asks for advance word only on a new agency director, a reduction in services, or closure. Adding a level needs an application under 67:61:02:04, but a medication isn’t a level. Policies are another matter. Under 67:61:02:05 they are “subject to the approval of the department as part of the accreditation process,” so a ketamine protocol belongs in the manual and in a conversation with the Office of Licensing and Accreditation before the first dose.

The administration definition creates a real wrinkle. Because 67:61:08:06 covers medication given “other than by the parenteral route,” an IV or intramuscular ketamine dose falls outside the program’s ordinary medication-administration scheme. In our reading, an infusion has to be given by a licensed prescriber or nurse acting under their own license and a prescriber’s order, not by assistive staff under the residential rule. Intranasal esketamine (Spravato) sits more comfortably inside the rule, but its FDA medication guide says it “can only be administered at healthcare settings certified in the SPRAVATO REMS program” and that the patient must be monitored “for at least 2 hours” afterward. Even a 3.7 program only has to keep nursing staff “on-call twenty-four hours a day, seven days a week” under 67:61:04:09, so someone qualified must be physically present for that window.

We found no South Dakota Board of Nursing position on RNs giving ketamine. The board’s Elective IV Infusion and Medication Therapy Guidelines, approved November 9, 2022, don’t mention it, describe IV therapy given as ordered by a qualified medical prescriber, and say “It is not within the RN scope to prescribe, order, or procure drugs or substances for medication administration.” The document calls itself a guideline rather than a rule.

Registrations and Reporting

Ketamine is a federal Schedule III substance (21 CFR 1308.13(c)(7)). The prescriber needs a DEA registration, and South Dakota separately requires practitioners who dispense, administer or prescribe controlled substances to hold a DOH controlled substance registration, applied for online. Keeping ketamine on site is tightly limited. Under 67:61:08:03 a residential program may store Schedule II, III or IV drugs only in an emergency box owned by a licensed pharmacy or physician and sealed by the supplying pharmacy, with no more than five doses of each injectable drug, and only for times when no pharmacy is available. In our reading, that rules out a standing infusion stock held by the program itself, so the prescriber’s own registration and supply chain have to carry it. The state prescription monitoring statute, SDCL 34-20E-2, has dispensers report “each prescription dispensed.” A dose given in the building isn’t a dispensed prescription in our reading, though a take-home prescription filled at a pharmacy would be reported in the usual way.

Nothing about ketamine treats opioid use disorder, so a ketamine protocol sits beside the MOUD policy above and never replaces it. Screening deserves extra care in a residential census. A resident whose history includes misuse of ketamine, PCP or other dissociatives is a poor candidate, and we’d hold off until withdrawal is well behind the person and depressive symptoms have persisted through standard treatment.

After Discharge: The Outpatient Clinic and Who Can Own It

A residential stay offers round-the-clock observation, which makes it a reasonable place to start a series. Most residents will need the rest of it after they leave, and that means a stand-alone outpatient clinic. South Dakota bars the corporate practice of medicine by statute. SDCL 36-4-8.1 says “it is the public policy of this state that a corporation may not practice medicine or osteopathy,” except as chapter 47-11 on medical corporations allows. It also gives corporations a narrow employment exception. A corporation that employs a licensed physician doesn’t practice medicine if the arrangement leaves the physician’s independent medical judgment alone, doesn’t let the corporation profit from the physician’s services beyond reasonable facility, equipment and administrative charges (it “may make additional charges reasonably associated with the services rendered”), and runs no longer than three years, renewable annually after that. The usual design pairs a physician-owned medical corporation with a management services organization that handles nonclinical work. Chapter 47-11 keeps the clinical entity in licensed hands. SDCL 47-11-3 admits only Medical Practice Act licensees as its officers, directors and shareholders, and 47-11-7 makes the corporation register with the Board of Medical and Osteopathic Examiners. Clinic setup, prescriber registrations and Spravato logistics get their own treatment under the ketamine heading of South Dakota Drug and Alcohol Outpatient Treatment Licensing.

Referrals between the residential program and the clinic need a lawyer’s eye. The federal Eliminating Kickbacks in Recovery Act, 18 U.S.C. § 220, reaches anyone who pays or accepts anything of value for steering patients to a recovery home or clinical treatment facility, and the penalty is up to $200,000, ten years in prison, or both “for each occurrence.” We haven’t researched whether South Dakota has a separate patient-brokering statute.

Staffing a South Dakota Residential Program

Coverage rules depend on the class. ARSD 67:61:04:09, last amended effective October 11, 2026 (53 SDR 41), requires a low-intensity residential program to operate seven days a week, twenty-four hours a day, with a staff member on duty at all times who is trained to respond to fires and natural disasters and to give first aid and CPR. An addiction counselor, addiction counselor supervisee or addiction counselor trainee must be available at least eight hours a day, five days a week, and on call around the clock. A detoxification program runs 24/7 whenever clients are present. The 3.7 program runs 24/7 with nursing on call at all hours and counseling staff on duty during normal daytime hours. If the DOH license applies, 44:78:03:02 adds the two-staff minimum. In our reading, none of these rules requires a nurse on site around the clock at any SUD level.

BLS reports a South Dakota median of $53,650 a year for substance abuse, behavioral disorder, and mental health counselors (OEWS, May 2025), with the 25th percentile at $45,650 and the 75th at $62,660, below the national median of $59,350. A residential program with a clinical director and four counselors paid at the median would spend about $268,250 a year on those five salaries alone, before night staff, nursing and benefits. That figure is a ceiling to plan around, and few South Dakota programs end up paying it. The reason is the state’s credential ladder. The Board of Addiction and Prevention Professionals recognizes Addiction Counselor Trainees, and the 2026 law (HB 1029, signed February 17, 2026) added supervisee titles. The act names no effective date, so the default in SDCL 2-14-16 put it in force on July 1, 2026. DSS then amended its staffing and counselor-qualification rules, effective October 11, 2026, to name the “addiction counselor supervisee” (67:61:04:09, 67:61:05:03). BAPP’s rewritten rules (in force October 11, 2026) ask more of a Licensed Addiction Counselor than a master’s degree: ARSD 20:80:16:03 wants 2,000 experience hours in a related field, with a minimum of 100 logged under a supervision plan and a minimum of 100 inside every one of the twelve core functions. Plenty of trainees and supervisees are somewhere inside that count, so a program can hire them at reduced wages under an LAC clinical director and trim clinical payroll by 40 to 60% compared with an all-licensed team. Recognition lasts one year and can be renewed no more than four times, so build the supervision plan around that limit. On the nursing side, one RN supervising several LPNs and trained unlicensed assistive personnel fits the 67:61:08 structure and costs less than RN coverage on every shift. The final staffing matrix comes from your bed count and your levels.

How to Submit Your South Dakota Residential Applications

Expect two filings. For the facility license, DOH asks for a written request to the Office of Health Facilities Licensure & Certification, 600 East Capitol Avenue, Pierre, SD 57501, and says “Application forms will be sent when eligibility for licensure or certification is evident.” The Health Facility Licensure page also carries the Apply Online link, and it warns that buildings “must meet state and federal construction, electrical, and plumbing requirements specific for the intended use.” Licensing questions go to Julie Jenssen, Licensing, Certification, and Enforcement Program Specialist, at 605-773-3901 or Julie.Jenssen@state.sd.us.

For accreditation, the DSS Office of Licensing and Accreditation takes first contact through its Become a Provider inquiry form. No numbered application is posted online. Under 67:61:02:04 the department makes “accreditation application forms available upon request,” and it returns an incomplete application without considering it. The office is at 700 Governors Drive, Pierre, SD 57501, and the portal lists 605.773.3165. The Division of Behavioral Health’s general mailbox is dssbh@state.sd.us. Because 67:61:10:03 applies to any residential facility “seeking accreditation,” we’d start the DOH request first or at least alongside the DSS inquiry.

What Slows South Dakota Residential Openings

The building, more than the paperwork, in our experience. DOH reviews physical environment, fire safety and construction under 44:78:02 and 44:78:03, and a house bought before anyone checked those chapters can need expensive changes. The second delay is the scope question above. An operator who assumes a 3.1 house is outside 44:78, and learns otherwise late, loses months.

Frequently Asked Questions

If you’d like a second set of eyes on whether your South Dakota house falls under ARSD 44:78, get in touch.

Sources

• South Dakota Codified Laws, SDCL 34-12 (34-12-1.1, 34-12-2, 34-12-6, 34-12-18): Hospitals and Related Institutions (checked October 15, 2026)
• South Dakota Codified Laws, SDCL 34-20A (34-20A-2, 2.1, 27, 44, 44.1, 77): Treatment and Prevention of Alcohol and Drug Abuse (checked October 15, 2026)
• ARSD 44:78: Inpatient Chemical Dependency Treatment Facility (checked October 15, 2026)
• ARSD 44:78:01:07: Plans of correction (checked October 15, 2026)
• ARSD 67:61:01:01: Definitions, including addiction counselor supervisee (checked October 15, 2026)
• ARSD 67:61:02: Accreditation of substance use disorder agencies (checked October 15, 2026)
• ARSD 67:61:04:09: General management, staffing, training, and hours of operation (checked October 15, 2026)
• ARSD 67:61:07:02: Client admission policies (checked October 15, 2026)
• ARSD 67:61:08: Medication control in residential programs (checked October 15, 2026)
• ARSD 67:61:10:03: Residential facility licensure under article 44:78 (checked October 15, 2026)
• ARSD 67:61:16:03: Low-intensity residential intensity of services (checked October 15, 2026)
• ARSD 67:61:17: Clinically-managed residential detoxification (checked October 15, 2026)
• ARSD 67:61:18: Medically-monitored intensive inpatient treatment (checked October 15, 2026)
• South Dakota Department of Health: Health Facility Licensure and Licensure contacts (checked October 15, 2026)
• DSS Office of Licensing and Accreditation: Behavioral Health and Become a Provider inquiry (checked October 15, 2026)
• DSS Division of Behavioral Health: Staff directory, February 2026 (PDF) (checked October 15, 2026)
• South Dakota Department of Health: 2025 Nursing Facility Moratorium Report (PDF) (checked October 15, 2026)
• CARF: ASAM Level of Care Certification and Find a Provider (checked October 15, 2026)
• ASAM: Level of Care Certification (checked October 15, 2026)
• DEA Diversion Control Division: Dear Registrant letter on the DATA-Waiver, January 12, 2023 (PDF) (checked October 15, 2026)
• South Dakota Department of Health: Controlled Substance Registration (checked October 15, 2026)
• South Dakota Board of Nursing: Elective IV Infusion and Medication Therapy Guidelines (PDF) (checked October 15, 2026)
• 21 CFR 1308.13(c)(7), via Cornell LII: Schedule III, ketamine (checked October 15, 2026)
• U.S. FDA: Spravato prescribing information and Medication Guide (checked October 15, 2026)
• SDCL 34-20E-2: Prescription drug monitoring program reporting (checked October 15, 2026)
• SDCL 36-4-8.1: Corporation prohibited from practice of medicine or osteopathy (checked October 15, 2026)
• SDCL 47-11 (47-11-3, 47-11-7): Medical Corporations (checked October 15, 2026)
• 18 U.S.C. § 220, via Cornell LII: Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories (checked October 15, 2026)
• BLS OEWS, May 2025, SOC 21-1018: South Dakota and national estimates (checked October 15, 2026)
• South Dakota Legislature, HB 1029 (2026): Bill history, signed by the Governor February 17, 2026, and SDCL 2-14-16: effective date of acts (checked October 15, 2026)
• Board of Addiction and Prevention Professionals: Licensing requirements and Renewal (checked October 15, 2026)
• Enrolled HB 1029 (2026), South Dakota Legislative Research Council: An Act to revise provisions related to the practice of addiction counseling and prevention services (PDF) (checked October 15, 2026)
• ARSD article 20:80, including 20:80:16:03 (LAC work experience, as amended 53 SDR 40, effective October 11, 2026): ARSD 20:80 (checked October 15, 2026)